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United Healthcare to Pay Administrative Penalty Under Consent Agreement with HEALTH

PROVIDENCE The Rhode Island Department of Health (HEALTH) has entered into a Consent Agreement with United Healthcare of New England, Inc. and United Healthcare Insurance Company. Under the terms of the agreement, United will pay an administrative penalty in the amount of $500,000 for its failure to file a material modification application with the Department of Health prior to entering into a prescription drug benefit administration agreement with OptumRX, Inc.

United notified the Department that it had entered into a prescription drug benefit administration agreement with OptumRX, Inc. on February 6, 2013, but did not file an application for material modification until June 3, 2013.

"This agreement reflects HEALTH's priority of protecting the health and safety of all Rhode Islanders by bringing closure to this situation with minimal disruption to the public," said Michael Fine, M.D., director of HEALTH. "The ways in which plans deal with their network and their utilization review process has a direct impact on providers and consumers and for that reason, HEALTH's regulations must be followed."

Under the terms of the agreement, HEALTH has provisionally approved United's application for a material modification pending full review and a decision by the Department. This provisional approval will remain in effect until HEALTH completes a full review and renders a decision on the application, which will occur on or before October 1, 2013. HEALTH's review process will also include a public comment period and may include a public hearing at the Department's discretion.

The full Consent Order may be viewed here (http://www.health.ri.gov/discipline/hospitals/UnitedConsentOrder201307.pdf) .

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Related links

Department or agency: Department of Health

Online: http://www.health.ri.gov

Release date: 07-12-2013

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